Rapid tranquilisation of acutely disturbed patient

Question 1

Overall approach to avert RT

Answer 1

1. de-escalation techniques
2. time-out
3. seclusion
4. restraint

Question 2

Desired outcome for RT

Answer 2

calmness
reduce risk of physical harm
reduce distress
do no harm

Question 3

Responsibilities of the doctor

Answer 3

1. history
2. MSE + PE
3. check notes for obvious contra-indications to medication or organic causes of acute presentation
4. MDT for RT
5. Legal status

Question 4

Risk assessment factors

Answer 4

diagnosis
substance misuse
current medication
delusions/hallucinations
age
level of agitation
impulsivity
hx uncooperativeness
response to medication
advanced statment

Question 5

Medication options for RT

Answer 5

1. benzodiazepines
   - >lorazepam
   - >midazolam
   - >diazepam
2. 1st gen antipsychotics
3. 2nd gen antipsychotics
4. combination

Question 6

Which benzo has the best evidence for RT

Answer 6

Lorazepam

-quick onset, short duration, good safety and tolerability

Question 7

Comapare loraz and Haloperidol 10mg IM + promethazine (25-50mh)

Answer 7

Combination more sedating + more EPSE, similar efficacy.

Question 8

Compare IM midaz and IM halo + promethazine

Answer 8

Both effective
Midaz more rapid sedation + resp sedation
not safe in PICUS/ other psych wards,

Question 9

why is diazepam not a popular choice for RT

Answer 9

erratic and slow IM absorption->not very popular for RT